{"id":2958,"date":"2025-06-06T18:17:24","date_gmt":"2025-06-06T17:17:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/ebn\/?p=2958"},"modified":"2025-06-06T18:17:24","modified_gmt":"2025-06-06T17:17:24","slug":"evidence-based-practice-approach-with-caution","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/ebn\/2025\/06\/06\/evidence-based-practice-approach-with-caution\/","title":{"rendered":"Evidence-based Practice: Approach with caution?"},"content":{"rendered":"

This weeks’ blog is by Adam Ferner, Child Nursing Student, City St George’s, University of London (adam.ferner@citystgeorges.ac.uk), and considers some of the injustices around EBP.<\/p>\n

http:\/\/www.adamferner.com\/<\/p>\n

\"\"<\/a><\/p>\n

Evidence-based practice (EBP) is at the heart of modern healthcare. Certainly, there is much to recommend EBP, which involves the integration of the best evidence, clinical experience and patient preference to inform decision-making (Fu et al., 2020). Nevertheless, any system used to generate and organise the \u2018best evidence\u2019 can be controversial and should be viewed with caution \u2013 and maybe even suspicion. Controversies around what constitutes \u2018best evidence\u2019 have been carefully analysed (Hanley et al., 2016). Nurse-researchers are themselves aware of the pitfalls of EBP and some now describe it as containing \u201cepistemic injustices\u201d (Haghiri-Vijeh, 2025), or unfairness relating to knowledge.<\/p>\n

Injustices in EBP<\/em><\/p>\n

Different forms of epistemic injustice are described. A patient can be victim of \u2018testimonial injustice\u2019 when they are regarded as unreliable because of a prejudice relating to their identity (Blease et al., 2017). For example, patients with Sickle Cell Disease (SCD) frequently experience testimonial injustice (Dhairyawan, 2024); SCD mainly affects Black and ethnically minoritised people, and staff can be unsympathetic to requests for pain relief because of the racist belief that Black people are more tolerant to pain (Sowemimo, 2023).<\/p>\n

\u2018Hermeneutical injustice\u2019 occurs when the tools (hermeneutics) to interpret patient experience are lacking. For instance, before the diagnostic category \u201cchronic fatigue syndrome\u201d was established, professionals were severely limited in their ability to understand patients; there were also scant resources which patients could use to describe their condition to others (Blease et al., 2017).<\/p>\n

Evidence-based practice has, to some extent, acknowledged these injustices and attempted to create more robust research frameworks by increasing patient involvement, and this is to be welcomed. However, such attempts imply that the EBP model is simply in need of tweaking; that injustices are the unfortunate result of marginalised social groups \u201cslipping through the cracks\u201d (Berenstain et al., 2022), rather than a more inherent issue.<\/p>\n

Oppression in EBP<\/em><\/p>\n

While exploring epistemic injustices, nurse-researchers tend to avoid the notion of \u2018epistemic oppression\u2019 (Dotson, 2014) which involves the systematic<\/em> discrediting of certain people as \u2018knowers\u2019 (with the capacity to form opinions and decisions) (Dotson, 2018). What has emerged from early modern race science, or \u2018scientific racism\u2019, is an example; it is designed to disenfranchise specific populations – Black and ethnically minoritised people, to the benefit of others – white Europeans (Sowemimo, 2023).<\/p>\n

Systems of epistemic oppression promote certain areas of research and actively ignore others, something that is sometimes called \u2018unknowing\u2019 (Code, 2008), and this unknowing generates \u2018silences\u2019 (Dillard-Wright et al., 2023). There are many such \u2018silences\u2019 in health research, such as the continued lack of evidence around trans care (Rigby, 2025), and repeated failures to fully represent the production of knowledge, including, but not limited to, contributions from Black nurses (Dillard-Wright et al., 2023). In this sense, the injustices described are not merely accidental but designed.<\/p>\n

Evidence-based practice relies on specific evidential hierarchies; Randomised Controlled Trials might be framed as a \u2018gold standard\u2019, while other forms of evidence, such as patient testimony and critique of theory, might be side-lined (Greenhalgh et al., 2015). Whilst the hierarchy can be tweaked, greater consideration must be given to ensure that methods of evidence generation are not more deeply compromised. Evidence showing that EBP is or is not unjust would need to meet the standards which are defined by the system itself; most critiques of EBP \u2013 including the texts referenced here \u2013 do not. It is for this reason, its structural avoidance of critique, that EBP should be approached with caution.<\/p>\n

References<\/u><\/p>\n

Berenstain, N., Dotson, K., Paredes, J., Ru\u00edz, E. & Silva N.K. (2022) Epistemic oppression, resistance, and resurgence. Contemporary Political Theory<\/em> 21<\/strong>:283\u2013314 https:\/\/doi.org\/10.1057\/s41296-021-00483-z<\/em><\/a>.<\/em><\/p>\n

Blease, C., Carel, H. & Geraghty, K. (2017) Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome. J Med Ethics<\/em> 43<\/strong>:549\u2013557 doi:10.1136\/medethics-2016-103691.<\/p>\n

Code, L. (2008) Advocacy, negotiation, and the politics of unknowing. The Southern <\/em>Journal of Philosophy<\/em> 46<\/strong>(1):32\u201351 https:\/\/doi.org\/10.1111\/j.2041-6962.2008.tb00152.x<\/a>.<\/p>\n

Dhairyawan, R. (2024) Unheard: the medical practice of silencing<\/em>. Trapeze: Orion Publishing.<\/p>\n

Dillard-Wright, J., Valderama-Wallace, C., Canty, L., Perron, A., De Sousa, I. & Gullick, J. (2023) What nursing chooses not to know: Practices of epistemic silence\/silencing. Nursing Philosophy<\/em> 24<\/strong>:e12443 https:\/\/doi.org\/10.1111\/nup.12443<\/em><\/a>.<\/em><\/p>\n

Dotson, K. (2014) Conceptualizing epistemic oppression. Social Epistemology<\/em> 28<\/strong>(2):115\u2013138.<\/p>\n

Dotson, K. (2018) Accumulating epistemic power. Philosophical Topics<\/em> 46<\/strong>(1):129\u2013154.<\/p>\n

Fu, Y.,\u00a0Wang, C.,\u00a0Hu, Y.\u00a0&\u00a0Muir-Cochrane, E.\u00a0(2020)\u00a0The barriers to evidence-based nursing implementation in mainland China: a qualitative content analysis.\u00a0Nursing & Health Sciences<\/em>,\u00a022<\/strong>(4),\u00a01038\u20131046.\u00a0https:\/\/doi.org\/10.1111\/nhs.12763<\/a>.<\/p>\n

Greenhalgh, T., Snow, R., Ryan, S., Rees, S. & Salisbury, H. (2015) Six \u2018biases\u2019 against patients and carers in evidence-based medicine. BMC Medicine<\/em> 13<\/strong>:200 doi 10.1186\/s12916-015-0437-x.<\/p>\n

Haghiri-Vijeh, R. (2025) Applying the concept of epistemic injustice as a philosophical window to examine discrimination experiences of LGBTQIA+ migrants with nurses. Nursing Philosophy<\/em> 26<\/strong>(1), 26:e70007https:\/\/doi.org\/10.1111\/nup.70007.<\/p>\n

Hanley, P., Chambers, B. & Haslam, J. (2016) Reassessing RCTs as the \u2018gold standard\u2019: synergy not separatism in evaluation designs. International Journal of Research & Method in Education<\/em>, 39<\/strong>(3), 287\u2013289 http:\/\/dx.doi.org\/10.1080\/1743727X.2016.1138457<\/p>\n

Rigby, F. (2025) Trans people and the NHS: the heat of the debate needs the light of evidence. The King\u2019s Fund Blog, <\/em>https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/blogs\/trans-people-nhs-debate-evidence<\/a>.<\/p>\n

Sowemimo, A. (2023) Divided: racism, medicine and why we need to decolonise healthcare<\/em>. Wellcome Collection publishing.<\/p>\n","protected":false},"excerpt":{"rendered":"

This weeks’ blog is by Adam Ferner, Child Nursing Student, City St George’s, University of London (adam.ferner@citystgeorges.ac.uk), and considers some of the injustices around EBP. http:\/\/www.adamferner.com\/ Evidence-based practice (EBP) is at the heart of modern healthcare. Certainly, there is much to recommend EBP, which involves the integration of the best evidence, clinical experience and patient […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":492,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3724,3819,1],"tags":[],"class_list":["post-2958","post","type-post","status-publish","format-standard","hentry","category-equality-and-diversity","category-nursing-research","category-uncategorized"],"yoast_head":"\nEvidence-based Practice: Approach with caution? - Evidence-Based Nursing blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/ebn\/2025\/06\/06\/evidence-based-practice-approach-with-caution\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evidence-based Practice: Approach with caution? - Evidence-Based Nursing blog\" \/>\n<meta property=\"og:description\" content=\"This weeks’ blog is by Adam Ferner, Child Nursing Student, City St George’s, University of London (adam.ferner@citystgeorges.ac.uk), and considers some of the injustices around EBP. http:\/\/www.adamferner.com\/ Evidence-based practice (EBP) is at the heart of modern healthcare. 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